What would you advise me to use as an oestrogen blocker?

We can look at ways to block your oestrogen production. We would look at GnRH blockers which come in the form of injections or nasal sprays. The GnRH blockers are the gold standard blocker, but are quite expensive at between £180 and £300 every 12 weeks depending on the option chosen. Some of the nasal sprays are cheaper than the injections. If you opt for the nasal spray, we will arrange a paper prescription for this if you live in the UK, unfortunately, Clear Chemist are unable to fill presc...

What alternatives are available to Finasteride?

If you have already tried Finasteride and have been advised to consider an alternative, we recommend either GnRH blockers (puberty blockers) or Spironolactone. The GnRH blockers are the gold standard blocker, but are quite expensive at between £180 and £300 every 12 weeks depending on the option chosen. Some of the nasal sprays are cheaper than the injections. If you opt for the nasal spray, we will arrange a paper prescription for this if you live in the UK. Unfortunately Clear Chemist are un...

Why do you prescribe finasteride?

Some people ask why Finasteride is used as a testosterone blocker. We advise it based on the WPATH standards of care (https://www.wpath.org/media/cms/Documents/SOC%20v7/SOC%20V7_English2012.pdf?_t=1613669341). Finasteride is known to be very safe and also requires less monitoring, and so they feel it is more suited to online prescribing. Both the effects of finasteride and your testosterone levels will be closely monitored and you always have the option to change it or add in another medication...

What is an anti-androgen?

Androgen (testosterone) blocking medicines can work in three ways: - Reduce the production of testosterone in the body - Stop testosterone having an effect on the body - Reduce male features of the body The commonly used anti-androgens are: Finasteride (https://www.medicines.org.uk/emc/product/6062/pil) - a very safe and simple tablet that works well in the majority of cases. This is the one we usually start with before moving on to stronger ones if needed. Spironolactone (https:/...

Are puberty blockers licensed for use in teenagers?

In transgender care puberty blockers are an unlicensed medication, also known as ‘off-label’, ‘unlicensed’ or ‘off-licence’. Because transgender people are a minority, very few medications are licensed for use in transgender healthcare. When medications are used in accordance with best medical practice, they are safe and effective. Unlicensed, off-licence and off-label refer only to the use of the medication beyond the terms of its licence, and do not refer to improper, illegal, unsafe or experi...

Are puberty blockers experimental?

The puberty delaying efficacy of puberty blockers in adolescents with severe gender dysphoria is well evidenced and not experimental (https://www.tandfonline.com/doi/full/10.1080/26895269.2020.1747768). In reality, there are over two decades of clinical practice supporting the use of puberty blockers in young people with gender dysphoria, with guidelines first being drafted in the mid-1990s (https://www.tandfonline.com/doi/full/10.1080/26895269.2020.1747768), and the use of these GnRH analogues ...

Are puberty blockers reversible?

Puberty blockers are fully reversible. Please see our myth buster for more information. (https://www.gendergp.com/debunking-the-myths-surrounding-puberty-blockers-trans-kids/)

How common is breast enlargement or reduction as a side effect of puberty blockers?

Our bodies respond in different ways to puberty blockers. Some patients experience either an increase or decrease in breast size during treatment. While specific data on the frequency of individual side effects is lacking, it is generally accepted that side effects are experienced by 1% to 10% of patients on blockers.

Can a patient stay on puberty blockers for life without being prescribed additional sex hormones?

Hormones are needed for healthy bone development, as such, we do not recommend the prescribing of puberty blockers indefinitely without gender affirming hormones. You can find more information about bone density here (https://care.gendergp.com/248362-When-would-a-patient-require-a-bone-screening--Why-dont-we-require-all-trans-patients-to-undergo-bone-screening).

According to the Tavistock clinic, a child needs to have had at least three periods before starting blockers as their reproductive system isn't fully formed. Is this true?

No. It is not a requirement in any way shape or form for periods to have started before blockers are given, and this is not suggested in any best practice guidelines for trans healthcare. The risks of psychological trauma caused by allowing menstruation outweighs any of the theoretical benefits posed by the Tavistock.

Are puberty blockers safe?

While the term ‘puberty blockers’ refers specifically to their use to prevent the progression of puberty in trans youth, or to suppress hormone production in trans adults, GnRH agonists and analogues are also widely used to manage conditions like precocious puberty, prostate cancer, endometriosis and infertility and are considered safe. You can get the full information about puberty blockers on our website (https://www.gendergp.com/puberty-blockers-exploring-the-facts-and-exploding-the-myths/).

What are puberty blockers?

Puberty blockers affect the production of a hormone called Gonadotropin Releasing Hormone (GnRH). This hormone is produced in the brain and stimulates the production of sex hormones (oestrogen or testosterone) from the ovaries or testicles. Blockers work by inhibiting the production of GnRH, which stops the production of the hormones that cause puberty and sexual development. Full information about puberty blockers can be found on our website (https://www.gendergp.com/puberty-blockers-exploring...

How do you measure capacity to consent?

Capacity to consent is assessed during our Information Gathering Session. This is where any potential difficulties in understanding - both of the implications of having gender-affirming treatments and the implications of not having them - would be highlighted. If there are any uncertainties a further Information Gathering Session may be required.

Is hormone therapy different to puberty blockers?

Gender-affirming hormone therapy, sometimes referred to as HRT (hormone replacement therapy) is not the same as puberty blockers. While blockers stop the production of endogenous hormones, hormone therapy replaces these with the desired hormone - oestrogen in transfeminine people, testosterone in transmasculine people, or maybe a bit of both in non-binary people.